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The Impact of 2012 United States Preventive Task Force panel update on PSA screening practices: a nationwide and state by state analysis.
Firas Abdollah, MD1, Deepansh Dalela, MD1, Moritz Hansen, MD2, Paul Han, MD3, Maxine Sun, MS4, Mani Menon, MD1, Quoc-Dien Trinh, MD4, Jesse Sammon, DO2.
1Henry Ford Hospital, Detroit, MI, USA, 2Maine Medical Center, Portland, ME, USA, 3Maine Medical Center Research Institute, Portland, ME, USA, 4Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA.

Normal 0 false false false EN-US JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-fareast-language:IT;} Background: Prostate specific antigen (PSA) screening is a widely debated practice in the US, given the concerns regarding over-diagnosis and over-treatment. In this context, the draft 2011 (finalized in May 2012) USPSTF recommended against PSA screening in all men. Our aim was to address the impact of this recommendation on PSA screening practice in US at nationwide level, as well as at state-by-state level. Methods: Survey responses from a cohort of 235,503 individuals aged ≥50 years (weighted population size of 50.324 million) who responded to the 2012 or 2014 Behavioral Risk Factor Surveillance System, were queried. Patients were asked if they had a PSA test in the 12 months prior to survey year, such that the BRFSS 2012 and 2014 reflected screening trends in the preceding year. A PSA test was considered as screening if it was performed without a history of prostate problem/cancer. Complex samples frequencies and logistic regression analyses were used to report outcomes. Results: Among individuals aged ≥50, 34.9% (95% CI: 34.4-35.4%) reported a PSA screening in 2012 survey vs. 31.9% (95% CI: 31.4-32.4%) in 2014 survey. When the same analyses were repeated at a state-by-state level, significant differences were observed between the states (figure). Specifically, Alabama and Alaska had the highest drop in PSA screening (7.5%), Utah and Vermont had virtually no change in PSA screening, while in few states there was a slight increase in PSA screening (0.1-2.5%). In multivariable analysis, year of survey (2014 vs. 2013 OR: 0.84, 95%CI: .80-.87) and State were independent predictors of PSA screening utilization after adjusting to age, race, education, income, health insurance, and marital status. Conclusions: There was an overall drop in PSA screening practice after the USPSTF recommendation against its use at a nationwide level. However, the magnitude of this phenomenon is subject to significant state-by-state heterogeneity. While some states witnessed a significant drop, others showed no change or even a slight increase in PSA screening. The impact of these variations on prostate cancer outcomes are still to be verified in future studies.


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